Healthcare Provider Details

I. General information

NPI: 1356552178
Provider Name (Legal Business Name): VAREE NATTIMON POOCHAREON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 05/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SW 57TH AVE SUITE 110
SOUTH MIAMI FL
33143-5528
US

IV. Provider business mailing address

914 COUNTRY CLUB PRADO
CORAL GABLES FL
33134-2117
US

V. Phone/Fax

Practice location:
  • Phone: 305-740-6181
  • Fax: 305-740-6140
Mailing address:
  • Phone: 305-283-9214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME104471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: